Get access to this article and to all of thebmj.com for 14 daysSign up today for a 14 day free trial

Gabriel Scally, director, WHO Collaborating Centre for Healthy Urban Environments, University of the West of England

gabriel.scally{at}btinternet.com

As the global economic crisis continues to have detrimental effects on health and health services around the world, there has never been a greater need for powerful advocates for public health at the heart of government. The need for an articulate and authoritative voice that can tell elected politicians the potential health consequences of their actions and inactions has been recognised in many democracies since the pinnacle of the sanitary revolution of the 19th century.

Many countries around the world have such a post designated in their governmental structures to provide expert advice on current and potential hazards to public health. There is, however, enormous variation in how this national role is positioned. In the countries of the European Union it ranges from a top level office occupied by a public health physician to a post at a lower level of government, or even separate from it, and occupied by an administrator rather than a physician.1

Perhaps the two most prominent posts globally are the surgeon general of the United States and the chief medical officer (CMO) of England, which incorporates the role of chief medical adviser to the UK government. These two posts show the advantages and hazards …

Get access to this article and to all of thebmj.com for 14 daysSign up today for a 14 day free trial